When The Sky Goes Boom

Eddie sat beside Mr. Parker and looked at me expectantly. Expectantly because I had already give him three of his favorite liver treats. 'If three, why not four, or even fourteen?' he seemed to be thinking. Regardless, he did not look especially nervous or anxious today.  However, two days prior this 30 kilo lab border collie cross put a dog shaped hole in the Parkers' kitchen screen door. Then he ran flat out for at least four kilometers, through the hammering rain and deepening mud. The Parkers found him several hours later, limping down a grid road, panting, bedraggled, exhausted. They brought him in to get him checked over because he still had a bit of a limp and because they didn't want this to happen again. Eddie had a storm phobia and it was the start of the summer storm season.

Many dogs have storm phobias and noise phobias. These are actually two different things, although there is considerable overlap. About 90% of storm phobia dogs also have a noise phobia to sudden loud sounds such as fireworks and cars backfiring. Curiously, the reverse is only true 75% of the time (noise phobia dogs who also have a storm phobia). Many also have other anxieties such as separation anxiety, but certainly a large number, like Eddie, do not. There is evidence that storm phobic dogs may also be reacting to the change in atmospheric pressure and to the flashing light in addition to the noise of the thunder. It is well known that dogs can hear the thunder approaching long before we do. This is a key part of the problem as many anxieties are worse when there is a wind up anticipatory phase.

I talked to Mr. Parker about three types of solutions: training, tricks and drugs. Most of the time you have to use at least two out of the three. Eddie needed all three.

Training is the best long term solution if you can get it to work. The chances of success are higher if you can consistently put the time needed into it. That said, I don't judge people who are unable to. My own dog still chases cars, steals entire cakes and barks at the vacuum like its the anti-Christ. There are a few training approaches, but the one I like best is counter-conditioning. For this find a long thunder storm sound clip. Start to play it very quietly and briefly while feeding your dog treats or his meal. Keep it below the level that sparks anxiety. Over time gradually increase the volume and duration, but always backing off immediately if he shows any signs of being worried. You are trying to create a deep association between a temporary bad thing, storms, and a permanent good thing, food. For most dogs the goodness of food will overpower the badness of storms, just so long as you take an extremely careful and gradual approach. This is best done well before storm season.

The tricks are fun. Get out you credit card and start surfing:
There are Mutt Muffs to block sound: http://www.safeandsoundpets.com/index.html
There are ThunderHuts, also to block sound: http://www.thunder-hut.com/
There are Doggles in case the lightning flashes are part of the problem: http://shop.doggles.com/
And there are ThunderShirts, to calm by creating a secure feeling "hug":
http://www.thundershirt.com/

Of these I have only seen the latter in action. My observation has been that the ThunderShirt seems to help many dogs, but that's it's unusual for it to be the sole answer. Looks cool though. Especially when matched with doggles and mutt muffs. A cheap DYI solution is to let the dog tell you what reduces the noise and flashes for him. This means leaving all your (inside!) doors open and letting him find a bed to crawl under or closet to stuff himself into.

And then finally the drugs. Some clients glaze over for all the above and radiate a strong "just give me the drugs" vibe. There are several but none are perfect and all require you to be very watchful of the weather forecast as they won't work once the anxiety is already building up. It is good to have some medication on hand for when you know that a storm is predicted later in the day. Most drugs are given an hour or so before the expected onset of anxiety. In severe cases it may even be worth having anti-anxiety meds prescribed to be given on a daily basis right through the storm season. Regardless, talk to your veterinarian as there is definitely no "one size fits all answer".

Ultimately some counter-conditioning, a ThunderShirt and an alprazolam prescription were the ticket for Eddie. He had a great summer until they went camping in an aluminum trailer and were caught in a hail storm...

An Open Letter To The Client In The Park Whose Name I Forgot

Dear Client,

It will come to me. Just give me a little longer and it will come to me. But in the meantime I do apologize. It was clearly awkward for both of us. You saying a friendly and hearty "Hi Dr. Schott!" and me an, I hope, equally friendly but unfortunately slightly less hearty "Hi.....!".

I recognized you for sure. I just couldn't remember your name. Or that of your pet. Or pets. Or their species. Or whether they were still alive. So I had to substitute "How's insert name of pet(s) here doing?" with "How are you?", which is ok, but not as good. I wish you had your dog(s) with you. That would have helped jog my memory. Should that have been a clue? Maybe you don't have dogs?

But the awkward bit was when it was obvious after you stopped to chat that I should introduce my family. This is when I could tell from your face that you realized I didn't remember your name. You're a kind and understanding person so you weren't hurt or disappointed, rather you felt bad that you put me in the position of having to try to remember. And I felt bad that you felt bad on top of the feeling bad that I couldn't remember. And now you probably feel bad that I felt bad that.... Never mind.

So here's the thing. I'm sure that you are smart in addition to being kind and understanding, so you know this already, but it still bears explaining. The thing is that you have a box in your brain marked "veterinarian" and another marked "dentist" and another marked "piano teacher" and so on. Each of these boxes contains one, or perhaps at most a handful, of names and faces. Pretty straight-forward to connect those names and faces. I have a box in my brain marked "clients". It contains upwards of 6,000 names and faces.  I have a decent memory, but... Well, you get it.

What you might not get though is that you don't even necessarily want to be one of the names I can connect to faces. Just like with a newspaper where far more bad news gets printed than good, far more names connect to faces when they are associated with something bad. It's just more memorable.

So, if I do remember your name it often means one of two things:
(a) You are one of those wacky clients staff talk about all the time.
or
(b) Your pets are way too sick way too often.

In other words, you should feel really good that I didn't remember your name. But give me a bit more time and I will remember. It's on the tip of my tongue. Just like when you're trying to remember that actor who was in that movie with what's-her-name who use to be married to what's-his-name in that other movie, you know? Right? Yes, that one.

Once again, my apologies.

Sincerely,

Dr. Philipp Schott BSc DVM

There Are Worms In My Heart

Ok, not technically right in the heart itself, but more on that later. And not technically my heart, at least probably not, but more on that later too.

It is "Heartworm Season" in Manitoba. Yes, it is. If you work in a veterinary clinic it is unmissable, unmistakable, unforgettable. It's not that our wards are packed full of dogs sick with heartworm disease, rather it's that the testing for and prevention of has to occur in a fairly narrow calendar window. Compounding this, for most people, it's convenient to get all the other annual stuff done at the same time since they've dragged Fido in anyway (incidentally, no actual dogs are named Fido, or Rover, or Rex, or Spot; some cats are though). Consequently, most of us see as many patients in a week in the spring as during a month in the winter.

I don't want to waste time spewing Basic Heartworm Facts. You can get those from, gulp, the internet (try www.veterinarypartner.com) or, better still, from your friendly neighbourhood veterinarian. Some of you even are "your friendly neighbourhood veterinarian", in which case said spewing would be even more time wasting. Instead, I want to touch on a few of the more unusual Cool Heartworm Facts (ok, some of you will consider these Gross Heartworm Facts, but I think they're cool).

Cool Heartworm Fact #1
Heartworm has probably been around forever (or a very long time that may as well be forever) with possible reports in the 1500s. It was first positively identified as such in 1847 in South America and then 1856 in the southeast USA. It has gradually been spreading north and west since, arriving in Manitoba in the 1980s.

Cool Heartworm Fact #2
However, despite that spread, large areas such as Saskatchewan, the Arctic and the West Coast do not have it. Not necessarily because of a lack of mosquitoes, but because of a lack of positive dogs already there. Mosquitoes are just flying syringes moving heartworm from one dog to another. This is why the mosquito paradise of northern Manitoba is heartworm free.

Cool Heartworm Fact #3
Heartworms can be huge, up to 35 cm / 14 inches. And they can be numerous, with infestations of over 100 worms reported.

Cool Heartworm Fact #4
The above-reported size and numbers are very rare, so most of the time "heartworm" is a misnomer. Most of the time the worms are hanging out in the pulmonary arteries leading away from the heart. Only if there are more than about 25 do they actually back up into the heart. But pulmonaryarteryworm is so much more unwieldy. Unless you are German like me, in which case you prefer more accurate but long and unwieldy words.

Cool Heartworm Fact #5
Wildlife can get heartworm. Logically foxes, coyotes, and wolves are most at risk, but it has also been reported in bears, raccoons, leopards, sea lions and, oddly enough, beavers. Cats and ferrets are at some potential risk as well depending on where you live, but that is a big subject best addressed separately.

Cool Heartworm Fact #6
Perhaps the coolest fact. Humans can also get heartworm. Heartworm positive mosquitoes bite us all the time and release microfilaria (baby heartworms) into our bloodstream all the time, but fortunately, we are not good hosts so 99.9%  (and probably a few more 9s after that) of the time they die. However, there have been at least 80 cases reported in humans in the US, mostly in the lungs but occasionally - shield your eyes if you are squeamish - the eyes and the testicles (!). These have mostly been mild infections. The main problem is that on lung x-rays a heartworm lesion looks very much like a tumour, prompting further invasive tests. Radiologists call it a "coin lesion". So if you overhear the interns whispering about this while they shoot sideways glances at you, ask about heartworm...

So You Want To Be A Veterinarian

Veterinarians love animals. This is a fundamental axiomatic truth, much like pilots loving airplanes, chefs loving food and librarians loving books. Given that the love of animals is widespread, the ambition to become a veterinarian is widespread as well. This spawns tremendous competition for the few spots in the veterinary schools, meaning that very high marks are required to get in. Consequently, and quite logically, it is animal lovers with excellent grades who populate the ranks of future veterinarians. But sometimes a third essential ingredient is missing. In fact, this ingredient is rarely even discussed, but it is the one element that more than any other determines whether these keen and idealistic students ultimately become happy veterinarians who maintain some of that keenness and idealism or whether they become disillusioned veterinarians who burn out and succumb to cynicism and regret.

That third essential ingredient is a love of people. The same high marks would easily get any prospective veterinary student into human medical school, but for many this is ruled out not just by the pull of their love for animals but, unfortunately, by the push of their, shall we say, discomfort around people. This is a problem. I tell every prospective veterinary student that comes through our clinic that veterinary medicine is not an animal business that happens to involve people, but a people business that happens to involve animals. I tell them that the sooner they understand this and accept this and embrace this, the sooner they will come to love their profession.

And why is that? The answer should be obvious. Until the dogs and cats and guinea pigs and rabbits and all others come marching in on their own replete with the ability to talk (and pay) we will have to work through their owners and keepers and guardians. You can only help animals by communicating clearly and empathetically with people. Moreover, even when this miraculous Dr. Dolittle day arrives we will still have staff to deal with. And staff are most assuredly people.

I have been chair of our professional disciplinary body for a number of years and can attest without a flicker of hesitation that far far more veterinarians come to grief through an inability to connect with people than through any failings in their surgical skills or medical knowledge.

And once you "get it" you see how fabulously interesting people are in all their freakish variety. And you see that we are a privileged profession as we are permitted to help people who are ironically often at their most human around animals. I remember with startling clarity the specific moment when this dawned on me. I was just about to enter the clinic through the back door. It was a sunny summer morning and as I opened the door I realized for the first time that I was looking forward to seeing the clients who were starting to become my regulars as much as I was looking forward to seeing their pets. It was at this moment that I decided to stay in practice and not go back to school to pursue research, which had been my original plan.

But all that said, the love of animals is still at the heart of things. I often think of a card we got many years ago from a young child who boldly wrote "I want to be a vat!" Yes, I too once aspired to be a large container, but I became an animal doctor instead and I have never regretted that decision.

That Distemperment Shot

You don't have to be in practice very long before you have someone come in with an out of control puppy, expressing relief that the puppy is about to get his "distemperment shot".
"He's getting that distemperment shot today, right doc? I can't wait until he settles down..."
"Um... yeah..."

To be fair it is an odd and confusing name. Its origins reach back to before the advent of modern medicine. Before the mid 19th century the prevailing theory was that good health resulted from a balance between the four "humors", also called "tempers": blood, yellow bile, black bile and phlegm. You can still see it in the language today - melancholy is Greek for black bile and indeed depressed people were thought to suffer from an imbalance of the humors with an excess of black bile. (For the record, actual bile is a greenish yellow, but you probably already knew that.) Dogs stricken with distemper were so profoundly ill and could potentially spew phlegm, bile and blood (in the stool), so they were though to be dis-tempered.

And what is it actually? Distemper is a disease caused by a virus that is related to the human measles virus, although the symptoms are very different. Dogs with distemper often have a constellation of symptoms including fever, heavy nasal discharge, breathing difficulties, vomiting, diarrhea, blindness and eventually nervous system symptoms up to and including seizures in some cases. It is spread through the discharge from a sick dog. The incubation period is up to about five days between exposure and first symptoms. There is no specific treatment, only supportive care which often has to be quite intensive to prevent the patient from succumbing and even so, about half of infected dogs will die.

Confusingly, "feline distemper", more correctly called panleukopenia, is not related to canine distemper. It is in fact a close cousin of canine parvo virus.

Incidentally though, canine distemper can also spread to wildlife. Foxes, coyotes and wolves are definitely susceptible and a mutated form has spread to seals as well where it has devastated some populations. Oddly, some marsupials are also vulnerable and distemper is theorized to have played a role in the extinction of the magnificent Tasmanian Tiger (also called the Thylacine).

That's all the bad news, but the good news is that the vaccines are extremely effective and safe. Consequently distemper is now very rare in areas where vaccination is common, such as here in the city. When we do see cases it is usually in puppies from remote communities. In the Arctic and in isolated First Nations communities it is still rampant.

Actually, I lied. That wasn't all the bad news. There is a worrying trend among some pet owners to refuse vaccination. How often to booster is a subject of some legitimate debate, but not to vaccinate at all is foolhardy (to be polite). It is still a small minority and fortunately their pets are protected by the fact that the majority of their neighbours are more sensible and responsible, so the virus cannot yet gain a foothold, but this could change. On the humans side whooping cough outbreaks are beginning to become more frequent in areas where vaccination rates are dropping. Whooping cough is sometimes fatal in babies.

Distemper is not just sometimes fatal.

And training is the remedy for "distemperment". Now, if we had a shot for that...

The Wild Boreal Chihuahua

By far and away the two most common questions I am asked by new puppy owners are "how big will he get?" and "what breed is he?". These are not subjects we are taught in veterinary school and although with experience our educated guesses improve, they are still just educated guesses. The frustrating part is that some clients judge our overall skill and knowledge as veterinarians based on these guesses and it can take years to live down a bad one. Consequently I've honed the art of being vague while sounding knowledgeable.

The question of breed guessing came to mind the other day when my own DNA test results came in. My wife had given me a "23 And Me" analysis as a gift and one of the findings was that I am 3.2% Neanderthal, which puts me in the 99th percentile of all people tested. I like to think that nobody would have guessed this, but my wife disagrees.

A similar test exists for dogs and I have had numerous clients over the years test their mixed breed dogs, perhaps frustrated by my knowledgeable vagueness.

The most popular of these tests purports to identify a truly astonishing range of breeds, from Affenpinscher to Yorkshire Terrier, including such oddities as Bergamasco, Glen of Imaal Terrier and Xolitzcuintli. I cannot vouch for the accuracy of this apparent extreme specificity and in fact, at the risk of hearing from someone's lawyer, I will confess to a tiny bit of skepticism. In contrast, for the majority of my DNA "23 And Me" is only willing to express confidence that it is generically "European", despite the fact that most of my known ancestors, back 13 generations in some cases, are German. But back to dog breeds I can say that despite the impressive list, the tests are missing one type and that that gap trips people up here, and I suspect throughout western and northern Canada.

For example, Mr. Jackson came in the other day with Bruiser, a 120 lb mound of muscle and fur that eats squirrels for lunch and begs to go outside when it's -40C. Mr. Jackson was perplexed because Bruiser's DNA breed test marked him as having a lot of Chihuahua. Bruiser resembles a Chihuahua the same way Mike Tyson resembles me.

So here's the thing.

The thing is that many of our clients get their dogs from shelters and the shelters here are full of dogs from remote First Nations communities in the north. So, am I saying that the northern Manitoba bush is seething with packs of wild boreal Chihuahuas? No. What I am saying is that when the indigenous people came to North America across the Bering land bridge around 15,000 years ago they brought dogs with them. These dogs are not any particular breed, they are simply, and beautifully I might add, "dogs". The Aztecs began breeding these dogs into a specific line that became what we now know as Chihuahuas. The DNA test then sometimes picks this up as the closest match for Bruiser and his friends. Look carefully at the next Chihuahua you see and take note of the curled tail. The other breeds with curled tales are all northern breeds in the family group sometimes called the Spitz type. Other members of this group are Chows and Akitas, who's DNA  sometimes also cross-reacts with our reserve dogs.

Fortunately for Mr. Jackson's ego Bruiser's test also highlighted husky and lab. Chihuahuas are actually very tough, but they do have an image problem with some people. Especially people who name their dog Bruiser.

I have a lot more to say about purebreds, crossbreds, mixed breeds etc., but I'll save that for another day.

Fish Of Death

Or at least "Fish Of Extreme Pain".
Soon after I graduated I decided to try to develop a sideline in fish medicine as way to  make myself more useful to the practice. Or at least less useless. The sensible among you will immediately see the logical flaws in trying to get people to bring their pet fish into the clinic. There are several such flaws. But my employers, bless them, were indulgent and patient with me. To give myself some credit, I was nothing if not enthusiastic. I made sure I had the best text books and I set to work writing brochures on a variety of fish health subjects. And then I waited for patients... and waited...

Until one day the owner of a nearby pet shop came in carrying a large ice cream pail. I'll call her Carla because that's her name and because even on the very off chance that she'll read this I don't think she'd be at all fazed by an implicit accusation of attempted murder.
"What have you got in the bucket Carla?"
"A fish! Actually two of them."
Imagine my excitement. Just imagine it.
I strode over to Carla and her bucket. Not walked, but strode. I peered into the bucket. Two fish indeed: a large, roughly eggplant sized, colourful fish with bold orange and white stripes and long feather-like things sticking out all over it, and a small, roughly walnut sized, dull brown coloured fish. There were two really interesting things about this scene. The first was that the big fish was a lionfish. (More on why that's really interesting in a moment.) The second was that the little fish was head-first halfway into the lionfish's mouth.

"Carla, that's a lionfish!"
"Yes, it's really expensive and it's choking on that stupid catfish!"
Which fish was more stupid struck me as a debatable point.
"I see..."
"Can you get the catfish out?"
"Um..."

So this is where I should explain what's really interesting about lionfish. Those cool looking feathery things are actually sharp spines (easily sharp enough to slice exam gloves) and are covered in venom. The venom has an entertaining array of potential effects including, and I quote, "extreme pain, nausea, vomiting, fever, breathing difficulties, convulsions, dizziness, redness on the affected area, headache, numbness, paresthesia (pins and needles), heartburn, diarrhea, and sweating. Rarely, such stings can cause temporary paralysis of the limbs, heart failure, and even death". Well, only "rarely" death, so that's ok.

"Well, can you?"
"Um..."
The lionfish actually looked distressed. The catfish was presumably even more distressed, but it was hard to tell.
There was no way to grasp the lionfish without touching the venomous spines and the standard aquarium wrangler's net wouldn't help, so, after a bit of pondering I came up with an idea. I found two long pieces of wood - this was a while ago, so I don't remember exactly, but they might have been leftover molding from a reno - and a large pair of surgical forceps. I wielded the wood pieces with my left hand like giant chopsticks to restrain the lionfish while carefully submerging my right hand with the forceps to firmly grasp the tail of the catfish.
Deep breath.
Then I yanked.
The catfish was free! However, I am sad to report that it did not live to enjoy its freedom. The catfish immediately succumbed to its injuries, or to the shock of the whole unpleasant event.  But the lionfish survived. And I survived. A mortality rate of only 33%. Not bad for a novice fish vet.

But that was pretty much the end of my short-lived fish vet career.

Years later we were in the Cayman Islands and met a local with a boat full of lionfish. It turns out that they are an invasive and aggressive species that is decimating native fish populations. The government there was paying a bounty on them. And they are steadily spreading northwards...